Aligning the Planets: the Role of Specialist Nurses in the Care of Patients with Non-ST Elevation Myocardial Infarction

Christi Deaton, Helen Cramer, Rachel Johnson, Maggie Evans, Adam Timmis, M. Justin Zaman, Harry Hemingway, Gene Feder

Research output: Contribution to journalArticle (Academic Journal)peer-review

2 Citations (Scopus)
306 Downloads (Pure)


Background: Studies have shown variation in care for patients with non-ST elevation myocardial infarction (NSTEMI), including in the roles of specialist and advanced practice nurses in diagnosis, treatment and coordination of care.
Aim: To describe the roles and responsibilities of specialist and advanced practice nurses in providing care for patients with NSTEMI.

Methods: Secondary analysis of observational field notes and interviews from an ethnographic study of variation in care for NSTEMI patients in 10 UK hospitals conducted 2011 - 2012. Data were thematically analysed to identify key concepts and themes related to the roles of specialist nurses.

Results: Seven of 10 hospitals had roles for specialist nurses in NSTEMI care. The major theme related to high demand and the complexity of patients and organisations (‘Aligning the planets’). Within this theme, nurses contributed to improving services or compensating for deficiencies (‘Making the system work versus making up for the system’). Data collection for audit could take precedence over time with patients (‘Paying worship to the paper’). Nurses expressed a sense of ownership of cardiovascular patients that drove their desire to provide quality of care (‘They are our patients’).

Conclusion: Specialist nurses’ roles for NSTEMI patients have developed based on needs and preferences within hospitals. Themes illustrated their roles in facilitating appropriate care, compensating for dysfunctional systems, and the frustrations inherent in delivering care for heterogeneous, often complicated patients in complex systems. Greater understanding of these roles and their effectiveness in improving patient care and outcomes would be beneficial.
Original languageEnglish
Pages (from-to)49-56
Number of pages8
JournalNursing Open
Issue number1
Early online date4 Nov 2016
Publication statusPublished - Jan 2017


  • Non-ST-elevation myocardial infarction
  • advanced practice
  • specialist nurses
  • nursing roles
  • variation in care


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